HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Al /SIT_ Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: S lll r NbYs !I L../
Property Tax ID #: y S-C' 1" -5-0 / - O 7 & 9 - Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Block No.
Mechanical _ Gas Tank —Gas Piping _ Shutters -Windows/Doors
� lectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ U`
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name H.,L, r P 2.4.d 1 1-r o r i_r.
Name: John Law
Company:Law's Electrical Service Inc.
Address:5158 NW Primm St
City: Pt St Lucie State: Fl
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Maii)ohnlaw515B@aol.com
Address: % 3.z3 N ti� AAlre 19i'i-
City: P s l e owa . r'.v State: kti
Zip Code: I19 J /(o Fax:
Phone No. / l 6 /b 2479 G RAr-
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License EC 13006370 29432
if value of construction is $2SOo or more, a RECORDED Notice of Commencement Is required.
If value of HVAC is $7,S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION
LIEN LAW INFOWATION.
-DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
City:
Zip: Phone
State:
Name:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Address:
City:
Name:
Address:
City:
i
; Zip:_Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the work dim ,,s.=•• — • - -- --
i certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no reapresentdtion that is granting a permit will au prize the permit holder to build the subject structure
whl hcturen{�,easfleIct consult wyth�your HloHome
e Owens Associationtandrrev ew ou deed for atnY restrittiots that s which may applystruhlhlt such
iin n accordance with the pprove plans, the nting of this Flor Florida Su (ding Lodes ted permit, I do and St.LLu ie County Amall
endmentsperform the Work
The following building permit applications
Pools, fences, walspsigns, creenr8 rooms and accessory uses to another non-residential use
accessory structures, swimming p
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result In your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first Inspection. If you intend to obtain financing, consult with lender or an attorney before
commencen-work or recorcling your NOTIGe or t.ommencerFry
M.
f
rs�a"�=
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Signature of ntracior/Ucense Hoiden
SignattgE of owner/ rector as Agent for owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrum t was acknowledged before me
-c 4 20 Eby
The forgoing instrument was acknowledged before me
this _r day of 25 , 20 —.AAby
this _LL day of
Name of person king statement
OR Produced identification
Name of person m;k3ng statement
Personally Known OR Produced Identification
Personally Known
Type of Identification
Type of Identification
Produced
Produced
Notary Public- State of Florida)
(Signature of Notary Public State o
" •-. RACHEL N
DAVIS
Commission No. 't•: .:. -. �, f biY GOMM19S10m
..
RACHEL M DA
�'dwR EXPIRES Janu
ry5,201H ;•j psy COMMISSION +YFF7
'-
(aWF M9 01 3 FlortcwNoiary
Mcgx=l
o January 8,
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION W&
REVIEW REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev, 8j2J17